| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 4TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $0 | $14K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $98 | $5K | 17.02% |
| CHARLES D. BLOCK3 Filed as: CHARLES BLOCK | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $637 | $57 | $694 | 2.60% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $637 | $42 | $679 | 2.54% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $920 | $0 | $920 | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | PO BOX 632886 CINCINNATI, OH 45263 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 700 W 47TH ST, SUITE 1100 KANSAS CITY, MO 64112 | UNUM INSURANCE COMPANY | $870 | $0 | $870 | 12.40% |
| CHARLES D. BLOCK3 Filed as: CHARLES BLOCK | 648 VILLAGE PARK DR, UNIT 208 WILMINGTON, NC 28405 | UNUM INSURANCE COMPANY | $91 | $9 | $100 | 1.43% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 70 | $36K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $145K |
| Other(4 contracts, 4 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 76 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.